Would you treat a patient with evidence of prostate cancer who refuses biopsy?

No. I cannot think of a situation where I would treat localized prostate cancer with radiotherapy without biopsy confirmation.

In the scenario provided above (PSA>15, PI-RADS 5), we cannot be positive the patient even has cancer. A meta-analysis (Barkovich et al., PMID 30807218) found PI-RADS 5 repre...

I agree with both Dr. @Dr. First Last and Dr. @Dr. First Last. The only way I would consider treating in such a scenario would be if the PSMA scan showed activity corresponding to the area of abnormality on the MRI. However, you can't order a PSMA scan if you don't have biopsy proven cancer (unless ...

No

I agree with Dr. @Dr. First Last. I would not treat this patient without a biopsy.

No.

The patient is "refusing" (as opposed to unable) to get a biopsy after having the reason for and necessity of having a biopsy explained to him. To me, that implies his supratentorial issues are probably more serious than his prostatic one, and treating him without proof of malignancy is just set...